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Geriatric Anesthesiology: Where Have We Been and Where Are We Going?

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Geriatric Anesthesiology

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Abstract

Geriatric anesthesiology is an emerging, important area more narrowly focused on the art, science, pharmacology, and physiology pertaining to the elderly surgical population. Geriatric medical care has evolved from an empiric discipline in the 1950s and 1960s to a largely evidence-based practice today. This introductory chapter presents some of the foundational concepts of geriatrics and a general approach to caring for geriatric patients presenting for surgery. The burgeoning elderly population has some very specific implications for anesthesiologists which are outlined in this chapter but covered extensively in more detail throughout the textbook. Finally, the history of geriatric anesthesia and educational concerns and opportunities related specifically to geriatric anesthesia are briefly described.

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References

  1. Reves JG, Greene N. Anesthesiology and the academic medical center: place and promise at the start of the new millennium, vol. 38. Philadelphia: Lippincott Williams & Wilkins; 2000.

    Google Scholar 

  2. Silverstein JH. In: Silverstein JH, Rooke GA, Reves JG, McLeskey CH, editors. Geriatric anesthesiology. 2nd ed. New York: Springer; 2008. p. 3–14.

    Chapter  Google Scholar 

  3. American Geriatrics S. Geriatrics-at-your fingertips. http://geriatricscareonline.org/ProductAbstract/geriatrics-at-your-fingertips/B005. 2016. Accessed 19 June 2016.

  4. Rovenstine EA. Geriatric anesthesia. Geriatrics. 1946;1:46–53.

    CAS  PubMed  Google Scholar 

  5. Lorhan PH. Geriatric anesthesia. Springfield: Charles C. Thomas; 1955.

    Google Scholar 

  6. Krechel SW. Anesthesia and the geriatric patient. Orlando: Grune & Stratton, Inc.; 1984.

    Google Scholar 

  7. Stephen CR. Geriatric anesthesia: principles and practice. Oxford: Butterworth-Heinemann Ltd; 1986.

    Google Scholar 

  8. Felts JA. Anesthesia and the geriatric patient. Philadelphia: W.B. Saunders; 1986.

    Google Scholar 

  9. Davenport HT. Anaesthesia in the elderly. Oxford: Butterworth-Heinemann Ltd.; 1986.

    Google Scholar 

  10. Davenport HT. Anaesthesia and the aged patient. Oxford: Blackwell Science Ltd; 1988.

    Google Scholar 

  11. Rooke GA. The history of geriatric anesthesia in the United States and the society for the advancement of geriatric anesthesia. Anesthesiol Clin. 2015;33(3):427–37.

    Article  PubMed  Google Scholar 

  12. Anesthesia ASoACoG. Syllabus on geriatric anesthesiology. 2002. http://www.sagahq.org/images/Syllabus.pdf. Accessed 11 Aug 2016.

  13. Anesthesiology ASoACoGAatSftAoG. A geriatric anesthesiology curriculum. 2009. http://sagahq.org/images/GeriCurric.pdf. Accessed 11 Aug 2016.

  14. Anesthesiology ASoACoGAatSftAoG. Frequently asked questions about anesthetic considerations for elderly patients. 2009. http://sagahq.org/images/FAQs.pdf. Accessed 11 Aug 2016.

  15. Surgeons AAoO. Management of hip fractures in the elderly, evidence- based clinical practice guideline. 2014. http://www.aaos.org/cc_files/aaosorg/research/guidelines/hipfxguideline.pdf. Accessed 11 Aug 2016.

  16. Anesthesia SftAoG. http://www.sagahq.org/. Accessed 11 Aug 2016.

  17. Society AG. Home page. http://www.americangeriatrics.org/. Accessed 11 Aug 2016.

  18. Solomon DH, Burton JR, Lundebjerg NE, Eisner J. The new frontier: increasing geriatrics expertise in surgical and medical specialties. J Am Geriatr Soc. 2000;48(6):702–4.

    Article  CAS  PubMed  Google Scholar 

  19. Society AG. New frontiers in geriatric research: an agenda for surgical and related medical specialties. http://newfrontiers.americangeriatrics.org/. Accessed 11 Aug 2016.

  20. Katz PR, Burton JR, Drach GW, et al. The Jahnigen scholars program: a model for faculty career development. J Am Geriatr Soc. 2009;57(12):2324–7.

    Article  PubMed  Google Scholar 

  21. Aging NIo. Grants for Early Medical/Surgical Specialists’ Transition to Aging Research (GEMSSTAR). https://www.nia.nih.gov/research/dgcg/grants-early-medical-surgical-specialists-transition-aging-research-gemsstar. Accessed 11 Aug 2016.

  22. Society AG. Research agenda. http://www.americangeriatrics.org/health_care_professionals/research__funding/research_agenda/. Accessed 11 Aug 2016.

  23. Society AG. Education of medical specialties. http://www.americangeriatrics.org/gsi/who_is_gsi/gsi_mission_goals. Accessed 11 Aug 2016.

  24. Association AA. Home page. http://www.ageanaesthesia.com/. Accessed 11 Aug 2016.

  25. Barnett SH. Manual of geriatric anesthesia. New York: Springer; 2013.

    Book  Google Scholar 

  26. Dodds C, Kumar CM, Veering BT. Oxford textbook of anaesthesia for the elderly patient. New York: Oxford University Press; 2014.

    Book  Google Scholar 

  27. United States Department of Commerce U.S. Census Bureau, West LA, Cole S, Goodkind D, He W. 65+ in the United States: 2010. U.S. Census Bureau Publication [government statistical report]. 2014. https://www.census.gov/content/dam/Census/library/publications/2014/demo/p23-212.pdf. Accessed 20 June 2016.

  28. Ortman J, Velkoff VA, Hogan H. An aging nation: the older population in the United States. Population estimates and projections. United States Department of Commerce U.S. Census Bureau [statistical report]. Available at: https://www.census.gov/prod/2014pubs/p25-1140.pdf (2014). p. 1–28. Accessed 20 June 2016.

  29. United States Department of Commerce U.S. Census Bureau Ortman J, Velkoff VA, Hogan H. An aging nation: the older population in the United States, Population estimates and projections 2014.

    Google Scholar 

  30. Etzioni DA, Liu JH, O’Connell JB, Maggard MA, Ko CY. Elderly patients in surgical workloads: a population-based analysis. Am Surg. 2003;69(11):961–5.

    PubMed  Google Scholar 

  31. United States Department of Health and Human Services AfCL. A profile of older Americans: 2011. 2016. http://www.aoa.acl.gov/Aging_Statistics/Profile/2011/8.aspx. Accessed 19 June 2016.

  32. U.S. Census Bureau Publication, West, LA, Cole, S, Goodkind, D, He, W. 65+ in the United States: 2010. U.S. Census Bureau Publication [government statistical report]. 2014. https://www.census.gov/content/dam/Census/library/publications/2014/demo/p23-212.pdf. Accessed 20 June 2016.

  33. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation. 2016;133(4):e38–60.

    Article  PubMed  Google Scholar 

  34. Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE. Survival experience of aged hip fracture patients. Am J Public Health. 1989;79(3):274–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Cameron ID, Chen JS, March LM, et al. Hip fracture causes excess mortality owing to cardiovascular and infectious disease in institutionalized older people: a prospective 5-year study. J Bone Miner Res Off J Am Soc Bone Miner Res. 2010;25(4):866–72.

    Google Scholar 

  36. Monson K, Litvak DA, Bold RJ. Surgery in the aged population: surgical oncology. Arch Surg (Chicago, Ill : 1960). 2003;138(10):1061–7.

    Article  Google Scholar 

  37. Gopinath B, Schneider J, Hartley D, et al. Incidence and predictors of hearing aid use and ownership among older adults with hearing loss. Ann Epidemiol. 2011;21(7):497–506.

    Article  PubMed  Google Scholar 

  38. Weiss AJ, Elixhauser A, Andrews RM. Characteristics of operating room procedures in U.S. hospitals, 2011: statistical brief #170. In: Healthcare cost and utilization project (HCUP) statistical briefs. Rockville: Agency for Health Care Policy and Research (US); 2006.

    Google Scholar 

  39. Manski RJ, Moeller JF, Chen H, Schimmel J, St Clair PA, Pepper JV. Patterns of older Americans’ health care utilization over time. Am J Public Health. 2013;103(7):1314–24.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Tiret L, Desmonts JM, Hatton F, Vourc'h G. Complications associated with anaesthesia–a prospective survey in France. Can Anaesth Soc J. 1986;33(3 Pt 1):336–44.

    Article  CAS  PubMed  Google Scholar 

  41. Pedersen T. Complications and death following anaesthesia. A prospective study with special reference to the influence of patient-, anaesthesia-, and surgery-related risk factors. Dan Med Bull. 1994;41(3):319–31.

    CAS  PubMed  Google Scholar 

  42. Khuri SF, Daley J, Henderson W, et al. The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg. 1998;228(4):491–507.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Fleisher LA, Pasternak LR, Herbert R, Anderson GF. Inpatient hospital admission and death after outpatient surgery in elderly patients: importance of patient and system characteristics and location of care. Arch Surg (Chicago, Ill: 1960). 2004;139(1):67–72.

    Article  Google Scholar 

  44. White PF, White LM, Monk T, et al. Perioperative care for the older outpatient undergoing ambulatory surgery. Anesth Analg. 2012;114(6):1190–215.

    Article  PubMed  Google Scholar 

  45. Aurini L, White PF. Anesthesia for the elderly outpatient. Curr Opin Anaesthesiol. 2014;27(6):563–75.

    Article  CAS  PubMed  Google Scholar 

  46. De Oliveira GS Jr, Holl JL, Lindquist LA, Hackett NJ, Kim JY, McCarthy RJ. Older adults and unanticipated hospital admission within 30 days of ambulatory surgery: an analysis of 53,667 ambulatory surgical procedures. J Am Geriatr Soc. 2015;63(8):1679–85.

    Article  PubMed  Google Scholar 

  47. Schwarze ML, Barnato AE, Rathouz PJ, et al. Development of a list of high-risk operations for patients 65 years and older. JAMA Surg. 2015;150(4):325–31.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Mathis MR, Naughton NN, Shanks AM, et al. Patient selection for day case-eligible surgery: identifying those at high risk for major complications. Anesthesiology. 2013;119(6):1310–21.

    Article  PubMed  Google Scholar 

  49. Rosnay d. Homeostasis. Principia Cybernetica Web. 1997. http://cleamc11.vub.ac.be/homeosta.html. Accessed 20 June 2016.

  50. Lindeman RD. Renal physiology and pathophysiology of aging. Contrib Nephrol. 1993;105:1–12.

    Article  CAS  PubMed  Google Scholar 

  51. Whalley LJ, Deary IJ, Appleton CL, Starr JM. Cognitive reserve and the neurobiology of cognitive aging. Ageing Res Rev. 2004;3(4):369–82.

    Article  PubMed  Google Scholar 

  52. Chow WB, Rosenthal RA, Merkow RP, et al. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012;215(4):453–66.

    Article  PubMed  Google Scholar 

  53. Bilimoria KY, Liu Y, Paruch JL, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg. 2013;217(5):833–42.e1-3.

    Article  PubMed  PubMed Central  Google Scholar 

  54. McGory ML, Kao KK, Shekelle PG, et al. Developing quality indicators for elderly surgical patients. Ann Surg. 2009;250(2):338–47.

    Article  PubMed  Google Scholar 

  55. Mohanty S RR, Russell MM, Neuman MD, Ko CY, Esnaola NF. Optimal perioperative management of the geriatric patient: best practices guideline from ACS NSQIP/American geriatrics society. 2016. https://www.facs.org/~/media/files/quality%20programs/geriatric/acs%20nsqip%20geriatric%202016%20guidelines.ashx.

  56. Walston J, Hadley EC, Ferrucci L, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging research conference on frailty in older adults. J Am Geriatr Soc. 2006;54(6):991–1001.

    Article  PubMed  Google Scholar 

  57. Amrock LG, Deiner S. The implication of frailty on preoperative risk assessment. Curr Opin Anaesthesiol. 2014;27(3):330–5.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Mohanty S, Rosenthal RA, Russell MM, Neuman MD, Ko CY, Esnaola NF. Optimal perioperative management of the geriatric patient: a best practices guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. J Am Coll Surg. 2016;222(5):930–47.

    Article  PubMed  Google Scholar 

  59. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.

    Article  PubMed  Google Scholar 

  60. Hubbard RE, Story DA. Patient frailty: the elephant in the operating room. Anaesthesia. 2014;69(Suppl 1):26–34.

    Article  PubMed  Google Scholar 

  61. Gillis C, Li C, Lee L, et al. Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology. 2014;121(5):937–47.

    Article  PubMed  Google Scholar 

  62. Strom C, Rasmussen LS, Sieber FE. Should general anaesthesia be avoided in the elderly? Anaesthesia. 2014;69(Suppl 1):35–44.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Aronovitch SA. Intraoperatively acquired pressure ulcers: are there common risk factors? Ostomy Wound Manage. 2007;53(2):57–69.

    PubMed  Google Scholar 

  64. Rubenstein LZ, Joseph T. Freeman award lecture: comprehensive geriatric assessment: from miracle to reality. J Gerontol A Biol Sci Med Sci. 2004;59(5):473–7.

    Article  PubMed  Google Scholar 

  65. Deschodt M, Flamaing J, Haentjens P, Boonen S, Milisen K. Impact of geriatric consultation teams on clinical outcome in acute hospitals: a systematic review and meta-analysis. BMC Med. 2013;11:48.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Federal Interagency Forum on Aging-Related Statistics. Older Americans 2016: key indicators of well-being. Federal Interagency Forum on Aging-Related Statistics. Washington, DC: U.S. Government Printing Office; August 2016. Retrieved 31st Jan 2017, from: https://agingstats.gov/docs/LatestReport/Older-Americans-2016-Key-Indicators-of-WellBeing.pdf.

  67. He W, Goodkind D, Kowal P, U.S. Census Bureau. An aging world, international population reports, P95/16-1. 2016. Retrieved 21 June 2016, from http://www.census.gov/content/dam/Census/library/publications/2016/demo/p95-16-1.pdf.

  68. Etzioni DA, Liu JH, Maggard MA, Ko CY. The aging population and its impact on the surgery workforce. Ann Surg. 2003;238(2):170–7.

    PubMed  PubMed Central  Google Scholar 

  69. Taffet GE. Physiology of aging. In: Cassel CK, Leipzig RM, Cohen HJ, Larson EB, Meier DE, Capello CF, editors. Geriatric medicine. New York: Springer Science + Business Media; 2003. p. 27–35.

    Chapter  Google Scholar 

  70. Barnett SA, Jankowski CJ, Ahktar S, editors. A geriatric anesthesiology curriculum. American Society of Anesthesiologists (ASA) committee on geriatric anesthesia: October 14th 2007. Retrieved from: http://sagahq.org/images/GeriCurric.pdf.

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Authors and Affiliations

  1. Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA

    Julie R. McSwain & J. G. Reves

  2. Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Sheila Ryan Barnett

  3. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA

    G. Alec Rooke

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  1. Julie R. McSwain
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  2. J. G. Reves
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  3. Sheila Ryan Barnett
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  4. G. Alec Rooke
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Correspondence to J. G. Reves .

Editor information

Editors and Affiliations

  1. Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA

    J. G. Reves

  2. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA

    Sheila Ryan Barnett

  3. Department of Anesthesia and Perioperative Medicine, Department of Anesthesiology, Medical University of South Carolina, Charleston, South Carolina, USA

    Julie R. McSwain

  4. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA

    G. Alec Rooke

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McSwain, J.R., Reves, J.G., Barnett, S.R., Rooke, G.A. (2018). Geriatric Anesthesiology: Where Have We Been and Where Are We Going?. In: Reves, J., Barnett, S., McSwain, J., Rooke, G. (eds) Geriatric Anesthesiology. Springer, Cham. https://doi.org/10.1007/978-3-319-66878-9_1

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  • DOI: https://doi.org/10.1007/978-3-319-66878-9_1

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